Provider Demographics
NPI:1942411160
Name:TANG, SUZANNE YEN (ND, LAC)
Entity Type:Individual
Prefix:DR
First Name:SUZANNE
Middle Name:YEN
Last Name:TANG
Suffix:
Gender:F
Credentials:ND, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2900 BRISTOL ST STE G106
Mailing Address - Street 2:
Mailing Address - City:COSTA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:92626-7913
Mailing Address - Country:US
Mailing Address - Phone:949-612-7247
Mailing Address - Fax:866-400-1904
Practice Address - Street 1:2900 BRISTOL ST STE G106
Practice Address - Street 2:
Practice Address - City:COSTA MESA
Practice Address - State:CA
Practice Address - Zip Code:92626-7913
Practice Address - Country:US
Practice Address - Phone:949-612-7247
Practice Address - Fax:866-400-1904
Is Sole Proprietor?:No
Enumeration Date:2007-05-28
Last Update Date:2022-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACA-9782171100000X
CAND-82175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath
No171100000XOther Service ProvidersAcupuncturist